Provider Demographics
NPI:1205076866
Name:CAROTHERS, IVONETE (BA)
Entity type:Individual
Prefix:MS
First Name:IVONETE
Middle Name:
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 JOY RD
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-9651
Mailing Address - Country:US
Mailing Address - Phone:972-342-6664
Mailing Address - Fax:
Practice Address - Street 1:13802 N HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1203
Practice Address - Country:US
Practice Address - Phone:512-249-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer